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CLIENT NAME: *PHONE: *
ADDRESS: *DATE: *
CONTACT PERSON: *EMAIL:

LOCAL CLIENTS ONLY
5-Tube Styrofoam Holder w/White Box Medium Canister (holds up to 12 tubes)
   Large Canister (holds up to 20 tubes)
BLOOD COLLECTION (Guide)
Blue (3.2% Na Citrate) 2.7 mL
Gray (Sodium Fluoride) 4 mL
Green (Heparin) 10 mL
Lavender (EDTA) 4 mL
Red (Non-additive) 10 mL
Royal Blue (Disodium EDTA) 7 mL
Red/Gray SST 7.5 mL
Yellow (ACD Solution A) 8.5 mL
COLLECTION KITS
include all collection and shipping supplies
Single IVF Donor (one shipper per donor)
Bulk IVF Donor (one shipper can hold specimens for up to 3 donors)
Single Infectious Disease (one shipper per patient)
Bulk Infectious Disease (one shipper can hold specimens for up to 3 patients)
Recurrent Miscarriage (6 ambient + 6 frozen tubes max)
Sperm DNA Decondensation (SDD)
SPECIMEN TRANSPORT
BD ProbeTec for GC/Chlamydia DNA Amplification - Urine
BD ProbeTec for GC/Chlamydia DNA Amplification - Swab
Male OR
Female
Frozen Transport Tube - Purple
Ova & Parasite Kit
Swab Transport (Aerobic/Anaerobic)
Serum Transfer Tube/Cap
Stool C & S
Viral Transport (Herpes / Chlamydia)
NEEDLES
21 Gauge x 1 1/4" (Eclipse)
22 Gauge x 1 1/4" (Eclipse)
Butterfly 23G x 1.9mm (Kawasumi)
Vacutainer Needle Holder (Regular)
SHIPPING SUPPLIES
FedEx Airbills
FedEx Lab Pak
Small Ambient Shipper (holds up to 6 tubes)
Large Ambient Shipper (holds up to 18 tubes)
Frozen (6 tubes) /Ambient (6 tubes) Combo Shipper
Medium Frozen Shipper (holds up to 6 tubes)
Aqui-Pak 6 Bay Tube Holder w/ Absorbent
Aqui-Pak 4 Bay Tube Holder w/ Absorbent
Small 95 kPa Specimen Bag
Large 95 kPa Specimen Bag
6 X 9 Biohazard Bag (to combine multi-patient biohazard bags in 1 shipper)
FORMS
Test Requisitions
Sperm DNA Decondensation (SDD) Patient Education Sheets
CYTOLOGY (Liquid-Based PAP Smear)
Cytyc - ThinPrep PreservCyt Collection Vials
Cervical Broom OR
Spatula and Cytobrush
TriPath - SurePath Prestain Collection Vials
Breakable Cervical Broom OR
Breakable Spatula and Cytobrush
URINE COLLECTION
Urine Bottle (24 HR)
Boric Acid
Hydrochloric Acid
No Additive
Routine Urine Analysis Tubes
5 oz. Urine Collection Cup
Urine C & S Collection
Single Vial Drug Screen Kit
Urine Transfer Device
 

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